Abstract
PurposeTo investigate the effects of Shared Decision-Making (SDM) using Routine Outcome Monitoring (ROM) primary on patients’ perception of Decisional Conflict (DC), which measures patients’ engagement in and satisfaction with clinical decisions, and secondary on working alliance and treatment outcomes.MethodMulti-centre two-arm matched-paired cluster randomised-controlled trial in Dutch specialist mental health care. SDM using ROM (SDMR) was compared with Decision-Making As Usual (DMAU). Outcomes were measured at baseline (T0) and 6 months (T1). Multilevel regression and intention-to-treat analyses were used. Post hoc analyses were performed on influence of subgroups and application of SDMR on DC.ResultsSeven teams were randomised to each arm. T0 was completed by 186 patients (51% intervention; 49% control) and T1 by 158 patients (51% intervention, 49% control). DC, working alliance, and treatment outcomes reported by patients did not differ significantly between two arms. Post hoc analyses revealed that SDMR led to less DC among depressed patients (p = 0.047, d =− 0.69). If SDMR was applied well, patients reported less DC (SDM: p = 0.000, d = − 0.45; ROM: p = 0.021, d = − 0.32), which was associated with better treatment outcomes.ConclusionExcept for patients with mood disorders, we found no difference between the arms for patient-reported DC. This might be explained by the less than optimal uptake of this generic intervention, which did not support patients directly. Regarding the positive influence of a higher level of applying SDM and ROM on less DC and better treatment outcomes, the results are encouraging for further investments in patient-oriented development and implementation of SDMR.
Highlights
Several studies have shown beneficial effects of Shared Decision-Making (SDM) in mental health care [1,2,3,4,5]
This study presents the results of a cluster randomisedcontrolled trial, testing the application of Shared DecisionMaking using Routine Outcome Monitoring (SDMR) in specialist mental health care
We have partially insight into the effects of SDM using ROM (SDMR) on symptom severity, merely for patients who followed short-term treatment. This is the first randomised-controlled trial (RCT) which investigated the combination of Shared Decision-Making using Routine Outcome Monitoring (SDMR) in specialist mental health care
Summary
Several studies have shown beneficial effects of Shared Decision-Making (SDM) in mental health care [1,2,3,4,5] Patients report that they are better informed and more actively engaged in treatment, experience higher satisfaction, and reduced decisional conflict, and patients show more treatment adherence. ROM is a personalised source of information and implies regular measurements of clinical outcomes during treatment. It provides feedback on the patients’ progress [10, 11] and has the potential to be a useful tool to involve patients in their treatment process [7, 8, 12, 13]. Research has shown that ROM can enhance the communication between patients and clinicians, and, when patients and clinicians both are provided with this feedback information, ROM can have beneficial effects on mental health status, especially for patients who are not responding to treatment favourably [11, 13,14,15,16]
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